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[post_content] => Glucagon-like peptide 1 (GLP-1) agonists, traditionally used to manage type 2 diabetes, have been increasingly prescribed off-label for weight loss.
There are four GLP-1 agonist medicines approved by the Therapeutic Goods Administration (TGA) for use in Australia for the management of Type 2 Diabetes:
Anouska Feszczur MPS[/caption]
‘Patients have told me cravings and appetite return with an insatiable force they’ve never experienced before,’ she said. ‘They also experience cravings for foods they had zero interest in while taking a GLP-1 agonist.’
The hunger and cravings tend to be extreme upon cessation, evening out over the space of weeks or months, said Ms Feszczur. This cessation symptom leads to another common post-treatment effect: weight gain.
‘Evidence shows stopping semaglutide leads to weight gain,’ said Ms Feszczur. ‘In one study, all participants put on two thirds of their weight back on in a year.’
Because patients often gain back the weight they lost post-treatment, other health benefits similarly erode.
‘For example, if a patient's blood pressure or blood sugar levels improve during treatment with a GLP-1 agonist, they can go back to where they were when they stop,’ she said.
Mood can also be impacted upon GLP-1 agonist cessation. ‘Patients who felt proud of themselves for losing weight can experience guilt, shame and despair,’ said Ms Feszczur. ’They've spent all this money on treatment, and suddenly the weight has come back on.’
Lastly, some patients have mentioned an impact on impulsive behaviours when the dopamine regulation effects of GLP-1 agonists appear to wear off.
‘Almost all patients have said they drink less alcohol because they just don't get the same buzz, and one patient even stopped chewing their nails,’ she said. ‘Some people have also indicated in forums that online shopping and gambling behaviour changed while they were on Ozempic.’
Those impulsive behaviours can return upon cessation, said Ms Feszczur – rendering the holiday period, where people tend to overeat, drink and spend, a tricky time to go off these medicines.
‘It could be quite distressing for patients who feel they have no control over impulsive behaviours.’
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[post_content] => When it comes to belladonna, the eyes have it. Pity it’s highly toxic...
During the Italian Renaissance of the 14–16th centuries, belladonna was a popular cosmetic product. Well-dressed women used juice from the berries of the plant to dilate their pupils, resulting in a fashionably seductive look. Hence the name belladonna, Italian for ‘beautiful woman’.1–6
But millennia before it helped make a fashion statement, belladonna was used as an anaesthetic, pain reliever and remedy for assorted ailments, not to mention as a hallucinogenic component of rituals. It was also used as an oral poison and to tip arrows.1,5,7
Deadly nightshade, murderer’s berries, sorcerer’s berries and even devil’s berries — as belladonna’s alternative names reveal, its not so ‘bella’ side was well known. The plant was associated with broom-riding witches and poison potions.3,4,8
Shakespeare described belladonna’s impact when referring to Juliet’s attempt to feign death to avoid marriage with Paris and escape with Romeo1,4,8:
Her blood is settled, and her joints are stiff: Life and these lips have long been separated; Death lies on her like an untimely frost upon the sweetest flower of all the field.
What is belladonna?
Atropa belladonna is an ornamental plant of the Solanaceae family. It is native to Europe, North Africa and Western Asia. Growing to a height of 150 centimetres in barren stony soil, belladonna has oval leaves, green-purple flowers and sweet black berries.3-5,9,10,12
The herbaceous perennial is highly poisonous, especially the leaves and fruit. They contain atropine, scopolamine and hyoscyamine alkaloids. Consuming the alkaloids can be deadly. Just touching the leaves may cause a rash.1,6-9,10
How it works
Belladonna’s alkaloids affect the body’s nervous system. Specifically, they block the neurotransmitter acetylcholine from binding to the central nervous system and to parasympathetic postganglionic muscarinic receptors.6,7,9-11
Toxic effects can be wide-ranging, as evidenced by the case of an 11-year-old Moroccan girl treated for belladonna toxicity by the intensive care team at the Mother and Child Hospital in Fes.5,7,9
‘She was given Atropa belladonna by an herbalist in a therapeutic interest,’ they reported. Her symptoms included dry mouth, confusion, incoherent speech, and an inability to recognise family members. She also presented with uncontrollable vomiting, visual disturbances, and hearing and visual hallucinations.7
Belladonna can also cause changes to saliva, sweat, pupil size, urination and digestive functions. It can also cause seizures, headaches and increased heart rate and blood pressure.10,11
Medical uses
Today, medicines containing alkaloids found in belladonna, such as atropine, are used in areas such as emergency medicine and anaesthesia.13
Interestingly, atropine is used as an antidote of organophosphate poisoning by reversing its muscarinic effects (such as vomiting, diarrhoea, bradycardia, miosis, sweating and salivation).13
Proving the eyes still have it, atropine is also indicated for use in optometry for conditions like uveitis, myopia progression, amblyopia and sometimes for eye exams.13 Overseas, transdermal scopolamine is sometimes used to help treat nausea and vomiting-related conditions.14
References
- Fletcher J. Uses and risks of belladonna. Medical News Today. 2017. At: https://www.medicalnewstoday.com/articles/318180
- Meriney SD, Fanselow EE. Acetylcholine in Synaptic Transmission. Academic Press 2019:345–67. At: https://www.sciencedirect.com/topics/neuroscience/atropa-belladonna
- Passos ID, Mironidou-Tzouveleki M. Hallucinogenic Plants in the Mediterranean Countries in Neuropathology of Drug Addictions and Substance Misuse Vol 2. Academic Press. 2016:761–72. At: https://www.sciencedirect.com/science/article/abs/pii/B9780128002124000716
- Morris SM. Belladonna: remedy with a dark past. Healthline. 2017. At: https://www.healthline.com/health/belladonna-dark-past
- Annisadmin. Atropa belladonna: deadly nightshade. Penny Dreadful Archives. 2016. At: https://pennydreadfularchives.wordpress.com/2016/05/31/atropa-belladonna-deadly-nightshade/
- DrugBank. Belladonna. 2017. At: https://go.drugbank.com/drugs/DB13913
- Berdai MA, Labib S, Chetouani K, et al. Atropa belladonna intoxication: a case report. Pan Afr Med J 2012;11:72. Epub 2012 Apr 17. At: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361210/
- Mann J. Belladonna, broomsticks and brain chemistry. Education in Chemistry. 2008. At: https://edu.rsc.org/feature/belladonna-broomsticks-and-brain-chemistry/2020099.article
- Karagoz I, Bilgi M, Boduc E, et al. Atropa belladonna and associated anticholinergic toxic syndrome: a case report. Bali Med J 2017;3(3):S90–S92. At: https://balimedicaljournal.org/index.php/bmj/article/view/673/pdf_330
- National Library of Medicine. MedlinePlus. Belladonna. 2022. At: https://medlineplus.gov/druginfo/natural/531.html
- Banasik M, Stedeford T. Plants, Poisonous (Humans). Encyclopedia of Toxicology (Third Edition). Academic Press. 2014. p970–78. At: https://www.sciencedirect.com/science/article/abs/pii/B9780123864543000488
- Jim’s Mowing. The Essential List of Poisonous Plants in Australia. At: https://www.jimsmowing.com.au/2021/01/the-essential-list-of-poisonous-plants-in-australia/#:~:text=For%20the%20formidable%20deadly%20nightshade,has%20become%20a%20fruitful%20one
- Rossi S, ed. Australian medicines handbook. 2023. At: https://amhonline.amh.net.au
- Pruthi S, ed. Mayo clinic. 2023. Scopolamine (Transdermal Route). At: www.mayoclinic.org/drugs-supplements/scopolamine-transdermal-route/side-effects/drg-20072848?p=1#:~:text=Scopolamine%20transdermal%20patch%20is%20used,group%20of%20medicines%20called%20anticholinergics
[post_title] => Belladonna: beautiful but deadly
[post_excerpt] => Before it helped make a fashion statement, belladonna was used as an anaesthetic, pain reliever and remedy for assorted ailments.
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[post_content] => The significant rise in Australian asthma deaths is cause for immediate and widespread concern. Here’s what experts say needs to change.
Asthma deaths are again on the rise, revealed new Australian Bureau of Statistics data recently released by the National Asthma Council Australia.
There were 467 asthma-related deaths in Australia in 2022, up from 355 deaths in 2021. Most (64%) were among women – with 299 female deaths versus 168 male deaths.
Those most at risk of death are women aged 75 and older, accounting for 45% of all deaths followed by men in this age group (18%).
This is the highest number of asthma deaths recorded since 2016-2017. Deaths were down in 2021 as a result of COVID-19 restrictions and lockdowns – leading to fewer respiratory infections and asthma exacerbations. However, asthma exacerbations have now returned to pre-pandemic levels and may even be slightly higher, warned National Asthma Council Australia Director and respiratory physician, Professor Peter Wark.
[caption id="attachment_24414" align="alignright" width="225"]
National Asthma Council Australia Director and respiratory physician, Professor Peter Wark[/caption]
This may be the result of the increase in virus infections we saw following the easing of COVID-19 restrictions but the main reasons are a result of the intrinsic problems underlying asthma management in Australia. ‘We're not accurately diagnosing asthma, and we are under-treating it,’ he said.
A need for better asthma diagnosis and control
There was a marked decline in lung function testing during COVID-19. Despite an increase in funding under the Medicare Benefits Schedule for spirometry, there has been a reduction of two thirds in spirometry being billed under the MBS compared to 2018–19, said Prof Wark.
‘Spirometry remains essential in the diagnosis of asthma and this will lead to under and overdiagnosis,’ said Prof Wark.
Up to 20% of people who present to a pharmacy for salbutamol haven't had their asthma confirmed by spirometry, said Advanced Practice Pharmacist and National Asthma Council Australia Clinical Executive Lead Debbie Rigby FPS.
‘Because [pharmacists] can dispense salbutamol over the counter without a prescription, we have a responsibility to ask the right questions to determine patients’ level of control,’ she said.
This could include asthma control tests. The Asthma Score is an example of such a test and comprises five questions. As part of this, pharmacists ask patients to rate their symptoms on a scale of one to five to indicate their asthma control over the last 4 weeks, including:
‘This more flexible approach to treatment is ideally suited to people with mild asthma, many of whom are now at risk because they are not using an ICS preventer.’
Pharmacists should take the opportunity to provide some much-needed education to patients about the benefits of the budesonide/formoterol combination, said Ms Rigby.
‘Formoterol works just as well and quickly as salbutamol, but they're also getting some inhaled corticosteroid – which helps with the inflammatory process going on in their lungs,’ she said. ‘Whereas with salbutamol, you're just helping with the bronchoconstriction. It's doing nothing about the underlying inflammation.’
‘Up to 20% of people who present to a pharmacy for salbutamol haven't had their asthma confirmed by spirometry.' Debbie Rigby FPSOnce patients exceed a lifetime cumulative dose of 500 mg of prednisone, the health risks increase dramatically – leaving younger people who use the medicine particularly at risk. ‘Only one or two courses of prednisone in 12 months significantly increases the risk of developing osteoporosis, diabetes and infections such as pneumonia.’ Females over the age of 12 are at greater risk of poor asthma outcomes, said Prof Wark. When female patients have ongoing problems with asthma control and prednisone is needed – a biologic should be considered, he said. ‘If you're not getting good asthma control, these alternative treatments work exceptionally well for everyone, including women.’
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[post_content] => With a plunge in vaccination rates following the COVID-19 pandemic peak, a new report says a concerted push is required, with a focus on national consistency.
The Grattan Institute’s A fair shot: How to close the vaccination gap report recommends action on a National Vaccines Partnership Agreement and harmonisation of the state-based regulations that determine pharmacists’ authority to deliver certain vaccines – which currently differ in each jurisdiction.
These recommendations echo PSA’s ongoing calls for a nationally consistent approach to vaccination, and demonstrate just how far we need to go to ensure equitable access to vaccination for all Australians, said PSA National President Dr Fei Sim FPS.
Australian Pharmacist takes a look at the groups with plummeting vaccination rates, and how empowering primary care professionals such as pharmacists can help to lift them.
Older Australians and Aboriginal and Torres Strait Islander peoples are missing out
Recommended vaccine uptake rates have continued to fall over the last couple of years, particularly among vulnerable groups. At the beginning of the 2023 winter, 2.5 million Australians over 65 years of age were not up to date with their COVID-19 vaccinations – a five-fold increase from 2022.
Other findings about COVID-19 vaccination include:
The report also says that Primary Health Networks (PHNs) should be required to make ongoing progress towards reaching national targets, and must be equipped with funding to support general practice, pharmacists, and aged care providers to promote vaccination in mainstream primary care.
The recent federal government commitment of 4 years of funding to support pharmacists to deliver free NIP vaccines to eligible people will improve access, increasing vaccination locations by up to 60%.
This move will also help to ensure patients can access vaccines from a trusted provider with whom they have an existing relationship.
Crucially, the report argues that ‘the federal government should work with state governments to make pharmacy vaccination regulations consistent across Australia’.
‘State regulations determine whether pharmacists can deliver particular vaccines, who can get particular vaccines from pharmacists, and whether a pharmacist vaccination is free,’ said the report. ‘The federal government’s independent Scope of Practice Review should harmonise these regulations by removing state-specific restrictions, [and] investigate opportunities to remove restrictions on the scope of practice of Aboriginal Health Workers and Aboriginal Health Practitioners.’
A nationally consistent schedule of pharmacist-administered vaccines is key to achieve equitable access to government-funded vaccines by all Australians, agreed Dr Sim.
‘We know that there is no one-size-fits-all approach to improving vaccine uptake, with the report rightly highlighting the need for a tailored approach to ensuring vulnerable cohorts don’t fall through the cracks,’ Dr Sim said.
‘The federal government’s move to open up NIP funding for pharmacist-administered vaccines is a welcome first step, but there is more work to be done to allow pharmacists to deliver all vaccines to patients of all ages.
‘Pharmacists can and should be utilised as trusted health care professionals, working hand in glove with the rest of the primary care team to break down the barriers to vaccination, from improving equity and access, to amplifying public health messages.’
[post_title] => We need a nationally consistent vaccination approach, says think tank
[post_excerpt] => With a plunge in vaccination rates following the COVID-19 pandemic peak, a new report says a focus on national consistency is required.
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[post_content] => Clozapine is indicated for the management of treatment-resistant schizophrenia. Its use is subject to strict regulatory and monitoring requirements due to potential toxicity, most notably agranulocytosis and neutropenia.
Each brand has its own protocol monitoring service1,2:
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[post_content] => Glucagon-like peptide 1 (GLP-1) agonists, traditionally used to manage type 2 diabetes, have been increasingly prescribed off-label for weight loss.
There are four GLP-1 agonist medicines approved by the Therapeutic Goods Administration (TGA) for use in Australia for the management of Type 2 Diabetes:
Anouska Feszczur MPS[/caption]
‘Patients have told me cravings and appetite return with an insatiable force they’ve never experienced before,’ she said. ‘They also experience cravings for foods they had zero interest in while taking a GLP-1 agonist.’
The hunger and cravings tend to be extreme upon cessation, evening out over the space of weeks or months, said Ms Feszczur. This cessation symptom leads to another common post-treatment effect: weight gain.
‘Evidence shows stopping semaglutide leads to weight gain,’ said Ms Feszczur. ‘In one study, all participants put on two thirds of their weight back on in a year.’
Because patients often gain back the weight they lost post-treatment, other health benefits similarly erode.
‘For example, if a patient's blood pressure or blood sugar levels improve during treatment with a GLP-1 agonist, they can go back to where they were when they stop,’ she said.
Mood can also be impacted upon GLP-1 agonist cessation. ‘Patients who felt proud of themselves for losing weight can experience guilt, shame and despair,’ said Ms Feszczur. ’They've spent all this money on treatment, and suddenly the weight has come back on.’
Lastly, some patients have mentioned an impact on impulsive behaviours when the dopamine regulation effects of GLP-1 agonists appear to wear off.
‘Almost all patients have said they drink less alcohol because they just don't get the same buzz, and one patient even stopped chewing their nails,’ she said. ‘Some people have also indicated in forums that online shopping and gambling behaviour changed while they were on Ozempic.’
Those impulsive behaviours can return upon cessation, said Ms Feszczur – rendering the holiday period, where people tend to overeat, drink and spend, a tricky time to go off these medicines.
‘It could be quite distressing for patients who feel they have no control over impulsive behaviours.’
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[post_content] => When it comes to belladonna, the eyes have it. Pity it’s highly toxic...
During the Italian Renaissance of the 14–16th centuries, belladonna was a popular cosmetic product. Well-dressed women used juice from the berries of the plant to dilate their pupils, resulting in a fashionably seductive look. Hence the name belladonna, Italian for ‘beautiful woman’.1–6
But millennia before it helped make a fashion statement, belladonna was used as an anaesthetic, pain reliever and remedy for assorted ailments, not to mention as a hallucinogenic component of rituals. It was also used as an oral poison and to tip arrows.1,5,7
Deadly nightshade, murderer’s berries, sorcerer’s berries and even devil’s berries — as belladonna’s alternative names reveal, its not so ‘bella’ side was well known. The plant was associated with broom-riding witches and poison potions.3,4,8
Shakespeare described belladonna’s impact when referring to Juliet’s attempt to feign death to avoid marriage with Paris and escape with Romeo1,4,8:
Her blood is settled, and her joints are stiff: Life and these lips have long been separated; Death lies on her like an untimely frost upon the sweetest flower of all the field.
What is belladonna?
Atropa belladonna is an ornamental plant of the Solanaceae family. It is native to Europe, North Africa and Western Asia. Growing to a height of 150 centimetres in barren stony soil, belladonna has oval leaves, green-purple flowers and sweet black berries.3-5,9,10,12
The herbaceous perennial is highly poisonous, especially the leaves and fruit. They contain atropine, scopolamine and hyoscyamine alkaloids. Consuming the alkaloids can be deadly. Just touching the leaves may cause a rash.1,6-9,10
How it works
Belladonna’s alkaloids affect the body’s nervous system. Specifically, they block the neurotransmitter acetylcholine from binding to the central nervous system and to parasympathetic postganglionic muscarinic receptors.6,7,9-11
Toxic effects can be wide-ranging, as evidenced by the case of an 11-year-old Moroccan girl treated for belladonna toxicity by the intensive care team at the Mother and Child Hospital in Fes.5,7,9
‘She was given Atropa belladonna by an herbalist in a therapeutic interest,’ they reported. Her symptoms included dry mouth, confusion, incoherent speech, and an inability to recognise family members. She also presented with uncontrollable vomiting, visual disturbances, and hearing and visual hallucinations.7
Belladonna can also cause changes to saliva, sweat, pupil size, urination and digestive functions. It can also cause seizures, headaches and increased heart rate and blood pressure.10,11
Medical uses
Today, medicines containing alkaloids found in belladonna, such as atropine, are used in areas such as emergency medicine and anaesthesia.13
Interestingly, atropine is used as an antidote of organophosphate poisoning by reversing its muscarinic effects (such as vomiting, diarrhoea, bradycardia, miosis, sweating and salivation).13
Proving the eyes still have it, atropine is also indicated for use in optometry for conditions like uveitis, myopia progression, amblyopia and sometimes for eye exams.13 Overseas, transdermal scopolamine is sometimes used to help treat nausea and vomiting-related conditions.14
References
- Fletcher J. Uses and risks of belladonna. Medical News Today. 2017. At: https://www.medicalnewstoday.com/articles/318180
- Meriney SD, Fanselow EE. Acetylcholine in Synaptic Transmission. Academic Press 2019:345–67. At: https://www.sciencedirect.com/topics/neuroscience/atropa-belladonna
- Passos ID, Mironidou-Tzouveleki M. Hallucinogenic Plants in the Mediterranean Countries in Neuropathology of Drug Addictions and Substance Misuse Vol 2. Academic Press. 2016:761–72. At: https://www.sciencedirect.com/science/article/abs/pii/B9780128002124000716
- Morris SM. Belladonna: remedy with a dark past. Healthline. 2017. At: https://www.healthline.com/health/belladonna-dark-past
- Annisadmin. Atropa belladonna: deadly nightshade. Penny Dreadful Archives. 2016. At: https://pennydreadfularchives.wordpress.com/2016/05/31/atropa-belladonna-deadly-nightshade/
- DrugBank. Belladonna. 2017. At: https://go.drugbank.com/drugs/DB13913
- Berdai MA, Labib S, Chetouani K, et al. Atropa belladonna intoxication: a case report. Pan Afr Med J 2012;11:72. Epub 2012 Apr 17. At: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361210/
- Mann J. Belladonna, broomsticks and brain chemistry. Education in Chemistry. 2008. At: https://edu.rsc.org/feature/belladonna-broomsticks-and-brain-chemistry/2020099.article
- Karagoz I, Bilgi M, Boduc E, et al. Atropa belladonna and associated anticholinergic toxic syndrome: a case report. Bali Med J 2017;3(3):S90–S92. At: https://balimedicaljournal.org/index.php/bmj/article/view/673/pdf_330
- National Library of Medicine. MedlinePlus. Belladonna. 2022. At: https://medlineplus.gov/druginfo/natural/531.html
- Banasik M, Stedeford T. Plants, Poisonous (Humans). Encyclopedia of Toxicology (Third Edition). Academic Press. 2014. p970–78. At: https://www.sciencedirect.com/science/article/abs/pii/B9780123864543000488
- Jim’s Mowing. The Essential List of Poisonous Plants in Australia. At: https://www.jimsmowing.com.au/2021/01/the-essential-list-of-poisonous-plants-in-australia/#:~:text=For%20the%20formidable%20deadly%20nightshade,has%20become%20a%20fruitful%20one
- Rossi S, ed. Australian medicines handbook. 2023. At: https://amhonline.amh.net.au
- Pruthi S, ed. Mayo clinic. 2023. Scopolamine (Transdermal Route). At: www.mayoclinic.org/drugs-supplements/scopolamine-transdermal-route/side-effects/drg-20072848?p=1#:~:text=Scopolamine%20transdermal%20patch%20is%20used,group%20of%20medicines%20called%20anticholinergics
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[post_excerpt] => Before it helped make a fashion statement, belladonna was used as an anaesthetic, pain reliever and remedy for assorted ailments.
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[post_content] => The significant rise in Australian asthma deaths is cause for immediate and widespread concern. Here’s what experts say needs to change.
Asthma deaths are again on the rise, revealed new Australian Bureau of Statistics data recently released by the National Asthma Council Australia.
There were 467 asthma-related deaths in Australia in 2022, up from 355 deaths in 2021. Most (64%) were among women – with 299 female deaths versus 168 male deaths.
Those most at risk of death are women aged 75 and older, accounting for 45% of all deaths followed by men in this age group (18%).
This is the highest number of asthma deaths recorded since 2016-2017. Deaths were down in 2021 as a result of COVID-19 restrictions and lockdowns – leading to fewer respiratory infections and asthma exacerbations. However, asthma exacerbations have now returned to pre-pandemic levels and may even be slightly higher, warned National Asthma Council Australia Director and respiratory physician, Professor Peter Wark.
[caption id="attachment_24414" align="alignright" width="225"] National Asthma Council Australia Director and respiratory physician, Professor Peter Wark[/caption]
This may be the result of the increase in virus infections we saw following the easing of COVID-19 restrictions but the main reasons are a result of the intrinsic problems underlying asthma management in Australia. ‘We're not accurately diagnosing asthma, and we are under-treating it,’ he said.
A need for better asthma diagnosis and control
There was a marked decline in lung function testing during COVID-19. Despite an increase in funding under the Medicare Benefits Schedule for spirometry, there has been a reduction of two thirds in spirometry being billed under the MBS compared to 2018–19, said Prof Wark.
‘Spirometry remains essential in the diagnosis of asthma and this will lead to under and overdiagnosis,’ said Prof Wark.
Up to 20% of people who present to a pharmacy for salbutamol haven't had their asthma confirmed by spirometry, said Advanced Practice Pharmacist and National Asthma Council Australia Clinical Executive Lead Debbie Rigby FPS.
‘Because [pharmacists] can dispense salbutamol over the counter without a prescription, we have a responsibility to ask the right questions to determine patients’ level of control,’ she said.This could include asthma control tests. The Asthma Score is an example of such a test and comprises five questions. As part of this, pharmacists ask patients to rate their symptoms on a scale of one to five to indicate their asthma control over the last 4 weeks, including:
‘This more flexible approach to treatment is ideally suited to people with mild asthma, many of whom are now at risk because they are not using an ICS preventer.’
Pharmacists should take the opportunity to provide some much-needed education to patients about the benefits of the budesonide/formoterol combination, said Ms Rigby.
‘Formoterol works just as well and quickly as salbutamol, but they're also getting some inhaled corticosteroid – which helps with the inflammatory process going on in their lungs,’ she said. ‘Whereas with salbutamol, you're just helping with the bronchoconstriction. It's doing nothing about the underlying inflammation.’
‘Up to 20% of people who present to a pharmacy for salbutamol haven't had their asthma confirmed by spirometry.' Debbie Rigby FPSOnce patients exceed a lifetime cumulative dose of 500 mg of prednisone, the health risks increase dramatically – leaving younger people who use the medicine particularly at risk. ‘Only one or two courses of prednisone in 12 months significantly increases the risk of developing osteoporosis, diabetes and infections such as pneumonia.’ Females over the age of 12 are at greater risk of poor asthma outcomes, said Prof Wark. When female patients have ongoing problems with asthma control and prednisone is needed – a biologic should be considered, he said. ‘If you're not getting good asthma control, these alternative treatments work exceptionally well for everyone, including women.’
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[post_content] => With a plunge in vaccination rates following the COVID-19 pandemic peak, a new report says a concerted push is required, with a focus on national consistency.
The Grattan Institute’s A fair shot: How to close the vaccination gap report recommends action on a National Vaccines Partnership Agreement and harmonisation of the state-based regulations that determine pharmacists’ authority to deliver certain vaccines – which currently differ in each jurisdiction.
These recommendations echo PSA’s ongoing calls for a nationally consistent approach to vaccination, and demonstrate just how far we need to go to ensure equitable access to vaccination for all Australians, said PSA National President Dr Fei Sim FPS.
Australian Pharmacist takes a look at the groups with plummeting vaccination rates, and how empowering primary care professionals such as pharmacists can help to lift them.
Older Australians and Aboriginal and Torres Strait Islander peoples are missing out
Recommended vaccine uptake rates have continued to fall over the last couple of years, particularly among vulnerable groups. At the beginning of the 2023 winter, 2.5 million Australians over 65 years of age were not up to date with their COVID-19 vaccinations – a five-fold increase from 2022.
Other findings about COVID-19 vaccination include:
The report also says that Primary Health Networks (PHNs) should be required to make ongoing progress towards reaching national targets, and must be equipped with funding to support general practice, pharmacists, and aged care providers to promote vaccination in mainstream primary care.
The recent federal government commitment of 4 years of funding to support pharmacists to deliver free NIP vaccines to eligible people will improve access, increasing vaccination locations by up to 60%.
This move will also help to ensure patients can access vaccines from a trusted provider with whom they have an existing relationship.
Crucially, the report argues that ‘the federal government should work with state governments to make pharmacy vaccination regulations consistent across Australia’.
‘State regulations determine whether pharmacists can deliver particular vaccines, who can get particular vaccines from pharmacists, and whether a pharmacist vaccination is free,’ said the report. ‘The federal government’s independent Scope of Practice Review should harmonise these regulations by removing state-specific restrictions, [and] investigate opportunities to remove restrictions on the scope of practice of Aboriginal Health Workers and Aboriginal Health Practitioners.’
A nationally consistent schedule of pharmacist-administered vaccines is key to achieve equitable access to government-funded vaccines by all Australians, agreed Dr Sim.
‘We know that there is no one-size-fits-all approach to improving vaccine uptake, with the report rightly highlighting the need for a tailored approach to ensuring vulnerable cohorts don’t fall through the cracks,’ Dr Sim said.
‘The federal government’s move to open up NIP funding for pharmacist-administered vaccines is a welcome first step, but there is more work to be done to allow pharmacists to deliver all vaccines to patients of all ages.
‘Pharmacists can and should be utilised as trusted health care professionals, working hand in glove with the rest of the primary care team to break down the barriers to vaccination, from improving equity and access, to amplifying public health messages.’
[post_title] => We need a nationally consistent vaccination approach, says think tank
[post_excerpt] => With a plunge in vaccination rates following the COVID-19 pandemic peak, a new report says a focus on national consistency is required.
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[post_content] => Clozapine is indicated for the management of treatment-resistant schizophrenia. Its use is subject to strict regulatory and monitoring requirements due to potential toxicity, most notably agranulocytosis and neutropenia.
Each brand has its own protocol monitoring service1,2:
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[post_content] => Glucagon-like peptide 1 (GLP-1) agonists, traditionally used to manage type 2 diabetes, have been increasingly prescribed off-label for weight loss.
There are four GLP-1 agonist medicines approved by the Therapeutic Goods Administration (TGA) for use in Australia for the management of Type 2 Diabetes:
Anouska Feszczur MPS[/caption]
‘Patients have told me cravings and appetite return with an insatiable force they’ve never experienced before,’ she said. ‘They also experience cravings for foods they had zero interest in while taking a GLP-1 agonist.’
The hunger and cravings tend to be extreme upon cessation, evening out over the space of weeks or months, said Ms Feszczur. This cessation symptom leads to another common post-treatment effect: weight gain.
‘Evidence shows stopping semaglutide leads to weight gain,’ said Ms Feszczur. ‘In one study, all participants put on two thirds of their weight back on in a year.’
Because patients often gain back the weight they lost post-treatment, other health benefits similarly erode.
‘For example, if a patient's blood pressure or blood sugar levels improve during treatment with a GLP-1 agonist, they can go back to where they were when they stop,’ she said.
Mood can also be impacted upon GLP-1 agonist cessation. ‘Patients who felt proud of themselves for losing weight can experience guilt, shame and despair,’ said Ms Feszczur. ’They've spent all this money on treatment, and suddenly the weight has come back on.’
Lastly, some patients have mentioned an impact on impulsive behaviours when the dopamine regulation effects of GLP-1 agonists appear to wear off.
‘Almost all patients have said they drink less alcohol because they just don't get the same buzz, and one patient even stopped chewing their nails,’ she said. ‘Some people have also indicated in forums that online shopping and gambling behaviour changed while they were on Ozempic.’
Those impulsive behaviours can return upon cessation, said Ms Feszczur – rendering the holiday period, where people tend to overeat, drink and spend, a tricky time to go off these medicines.
‘It could be quite distressing for patients who feel they have no control over impulsive behaviours.’
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[post_content] => When it comes to belladonna, the eyes have it. Pity it’s highly toxic...
During the Italian Renaissance of the 14–16th centuries, belladonna was a popular cosmetic product. Well-dressed women used juice from the berries of the plant to dilate their pupils, resulting in a fashionably seductive look. Hence the name belladonna, Italian for ‘beautiful woman’.1–6
But millennia before it helped make a fashion statement, belladonna was used as an anaesthetic, pain reliever and remedy for assorted ailments, not to mention as a hallucinogenic component of rituals. It was also used as an oral poison and to tip arrows.1,5,7
Deadly nightshade, murderer’s berries, sorcerer’s berries and even devil’s berries — as belladonna’s alternative names reveal, its not so ‘bella’ side was well known. The plant was associated with broom-riding witches and poison potions.3,4,8
Shakespeare described belladonna’s impact when referring to Juliet’s attempt to feign death to avoid marriage with Paris and escape with Romeo1,4,8:
Her blood is settled, and her joints are stiff: Life and these lips have long been separated; Death lies on her like an untimely frost upon the sweetest flower of all the field.
What is belladonna?
Atropa belladonna is an ornamental plant of the Solanaceae family. It is native to Europe, North Africa and Western Asia. Growing to a height of 150 centimetres in barren stony soil, belladonna has oval leaves, green-purple flowers and sweet black berries.3-5,9,10,12
The herbaceous perennial is highly poisonous, especially the leaves and fruit. They contain atropine, scopolamine and hyoscyamine alkaloids. Consuming the alkaloids can be deadly. Just touching the leaves may cause a rash.1,6-9,10
How it works
Belladonna’s alkaloids affect the body’s nervous system. Specifically, they block the neurotransmitter acetylcholine from binding to the central nervous system and to parasympathetic postganglionic muscarinic receptors.6,7,9-11
Toxic effects can be wide-ranging, as evidenced by the case of an 11-year-old Moroccan girl treated for belladonna toxicity by the intensive care team at the Mother and Child Hospital in Fes.5,7,9
‘She was given Atropa belladonna by an herbalist in a therapeutic interest,’ they reported. Her symptoms included dry mouth, confusion, incoherent speech, and an inability to recognise family members. She also presented with uncontrollable vomiting, visual disturbances, and hearing and visual hallucinations.7
Belladonna can also cause changes to saliva, sweat, pupil size, urination and digestive functions. It can also cause seizures, headaches and increased heart rate and blood pressure.10,11
Medical uses
Today, medicines containing alkaloids found in belladonna, such as atropine, are used in areas such as emergency medicine and anaesthesia.13
Interestingly, atropine is used as an antidote of organophosphate poisoning by reversing its muscarinic effects (such as vomiting, diarrhoea, bradycardia, miosis, sweating and salivation).13
Proving the eyes still have it, atropine is also indicated for use in optometry for conditions like uveitis, myopia progression, amblyopia and sometimes for eye exams.13 Overseas, transdermal scopolamine is sometimes used to help treat nausea and vomiting-related conditions.14
References
- Fletcher J. Uses and risks of belladonna. Medical News Today. 2017. At: https://www.medicalnewstoday.com/articles/318180
- Meriney SD, Fanselow EE. Acetylcholine in Synaptic Transmission. Academic Press 2019:345–67. At: https://www.sciencedirect.com/topics/neuroscience/atropa-belladonna
- Passos ID, Mironidou-Tzouveleki M. Hallucinogenic Plants in the Mediterranean Countries in Neuropathology of Drug Addictions and Substance Misuse Vol 2. Academic Press. 2016:761–72. At: https://www.sciencedirect.com/science/article/abs/pii/B9780128002124000716
- Morris SM. Belladonna: remedy with a dark past. Healthline. 2017. At: https://www.healthline.com/health/belladonna-dark-past
- Annisadmin. Atropa belladonna: deadly nightshade. Penny Dreadful Archives. 2016. At: https://pennydreadfularchives.wordpress.com/2016/05/31/atropa-belladonna-deadly-nightshade/
- DrugBank. Belladonna. 2017. At: https://go.drugbank.com/drugs/DB13913
- Berdai MA, Labib S, Chetouani K, et al. Atropa belladonna intoxication: a case report. Pan Afr Med J 2012;11:72. Epub 2012 Apr 17. At: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361210/
- Mann J. Belladonna, broomsticks and brain chemistry. Education in Chemistry. 2008. At: https://edu.rsc.org/feature/belladonna-broomsticks-and-brain-chemistry/2020099.article
- Karagoz I, Bilgi M, Boduc E, et al. Atropa belladonna and associated anticholinergic toxic syndrome: a case report. Bali Med J 2017;3(3):S90–S92. At: https://balimedicaljournal.org/index.php/bmj/article/view/673/pdf_330
- National Library of Medicine. MedlinePlus. Belladonna. 2022. At: https://medlineplus.gov/druginfo/natural/531.html
- Banasik M, Stedeford T. Plants, Poisonous (Humans). Encyclopedia of Toxicology (Third Edition). Academic Press. 2014. p970–78. At: https://www.sciencedirect.com/science/article/abs/pii/B9780123864543000488
- Jim’s Mowing. The Essential List of Poisonous Plants in Australia. At: https://www.jimsmowing.com.au/2021/01/the-essential-list-of-poisonous-plants-in-australia/#:~:text=For%20the%20formidable%20deadly%20nightshade,has%20become%20a%20fruitful%20one
- Rossi S, ed. Australian medicines handbook. 2023. At: https://amhonline.amh.net.au
- Pruthi S, ed. Mayo clinic. 2023. Scopolamine (Transdermal Route). At: www.mayoclinic.org/drugs-supplements/scopolamine-transdermal-route/side-effects/drg-20072848?p=1#:~:text=Scopolamine%20transdermal%20patch%20is%20used,group%20of%20medicines%20called%20anticholinergics
[post_title] => Belladonna: beautiful but deadly
[post_excerpt] => Before it helped make a fashion statement, belladonna was used as an anaesthetic, pain reliever and remedy for assorted ailments.
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[post_content] => The significant rise in Australian asthma deaths is cause for immediate and widespread concern. Here’s what experts say needs to change.
Asthma deaths are again on the rise, revealed new Australian Bureau of Statistics data recently released by the National Asthma Council Australia.
There were 467 asthma-related deaths in Australia in 2022, up from 355 deaths in 2021. Most (64%) were among women – with 299 female deaths versus 168 male deaths.
Those most at risk of death are women aged 75 and older, accounting for 45% of all deaths followed by men in this age group (18%).
This is the highest number of asthma deaths recorded since 2016-2017. Deaths were down in 2021 as a result of COVID-19 restrictions and lockdowns – leading to fewer respiratory infections and asthma exacerbations. However, asthma exacerbations have now returned to pre-pandemic levels and may even be slightly higher, warned National Asthma Council Australia Director and respiratory physician, Professor Peter Wark.
[caption id="attachment_24414" align="alignright" width="225"] National Asthma Council Australia Director and respiratory physician, Professor Peter Wark[/caption]
This may be the result of the increase in virus infections we saw following the easing of COVID-19 restrictions but the main reasons are a result of the intrinsic problems underlying asthma management in Australia. ‘We're not accurately diagnosing asthma, and we are under-treating it,’ he said.
A need for better asthma diagnosis and control
There was a marked decline in lung function testing during COVID-19. Despite an increase in funding under the Medicare Benefits Schedule for spirometry, there has been a reduction of two thirds in spirometry being billed under the MBS compared to 2018–19, said Prof Wark.
‘Spirometry remains essential in the diagnosis of asthma and this will lead to under and overdiagnosis,’ said Prof Wark.
Up to 20% of people who present to a pharmacy for salbutamol haven't had their asthma confirmed by spirometry, said Advanced Practice Pharmacist and National Asthma Council Australia Clinical Executive Lead Debbie Rigby FPS.
‘Because [pharmacists] can dispense salbutamol over the counter without a prescription, we have a responsibility to ask the right questions to determine patients’ level of control,’ she said.This could include asthma control tests. The Asthma Score is an example of such a test and comprises five questions. As part of this, pharmacists ask patients to rate their symptoms on a scale of one to five to indicate their asthma control over the last 4 weeks, including:
‘This more flexible approach to treatment is ideally suited to people with mild asthma, many of whom are now at risk because they are not using an ICS preventer.’
Pharmacists should take the opportunity to provide some much-needed education to patients about the benefits of the budesonide/formoterol combination, said Ms Rigby.
‘Formoterol works just as well and quickly as salbutamol, but they're also getting some inhaled corticosteroid – which helps with the inflammatory process going on in their lungs,’ she said. ‘Whereas with salbutamol, you're just helping with the bronchoconstriction. It's doing nothing about the underlying inflammation.’
‘Up to 20% of people who present to a pharmacy for salbutamol haven't had their asthma confirmed by spirometry.' Debbie Rigby FPSOnce patients exceed a lifetime cumulative dose of 500 mg of prednisone, the health risks increase dramatically – leaving younger people who use the medicine particularly at risk. ‘Only one or two courses of prednisone in 12 months significantly increases the risk of developing osteoporosis, diabetes and infections such as pneumonia.’ Females over the age of 12 are at greater risk of poor asthma outcomes, said Prof Wark. When female patients have ongoing problems with asthma control and prednisone is needed – a biologic should be considered, he said. ‘If you're not getting good asthma control, these alternative treatments work exceptionally well for everyone, including women.’
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[post_content] => With a plunge in vaccination rates following the COVID-19 pandemic peak, a new report says a concerted push is required, with a focus on national consistency.
The Grattan Institute’s A fair shot: How to close the vaccination gap report recommends action on a National Vaccines Partnership Agreement and harmonisation of the state-based regulations that determine pharmacists’ authority to deliver certain vaccines – which currently differ in each jurisdiction.
These recommendations echo PSA’s ongoing calls for a nationally consistent approach to vaccination, and demonstrate just how far we need to go to ensure equitable access to vaccination for all Australians, said PSA National President Dr Fei Sim FPS.
Australian Pharmacist takes a look at the groups with plummeting vaccination rates, and how empowering primary care professionals such as pharmacists can help to lift them.
Older Australians and Aboriginal and Torres Strait Islander peoples are missing out
Recommended vaccine uptake rates have continued to fall over the last couple of years, particularly among vulnerable groups. At the beginning of the 2023 winter, 2.5 million Australians over 65 years of age were not up to date with their COVID-19 vaccinations – a five-fold increase from 2022.
Other findings about COVID-19 vaccination include:
The report also says that Primary Health Networks (PHNs) should be required to make ongoing progress towards reaching national targets, and must be equipped with funding to support general practice, pharmacists, and aged care providers to promote vaccination in mainstream primary care.
The recent federal government commitment of 4 years of funding to support pharmacists to deliver free NIP vaccines to eligible people will improve access, increasing vaccination locations by up to 60%.
This move will also help to ensure patients can access vaccines from a trusted provider with whom they have an existing relationship.
Crucially, the report argues that ‘the federal government should work with state governments to make pharmacy vaccination regulations consistent across Australia’.
‘State regulations determine whether pharmacists can deliver particular vaccines, who can get particular vaccines from pharmacists, and whether a pharmacist vaccination is free,’ said the report. ‘The federal government’s independent Scope of Practice Review should harmonise these regulations by removing state-specific restrictions, [and] investigate opportunities to remove restrictions on the scope of practice of Aboriginal Health Workers and Aboriginal Health Practitioners.’
A nationally consistent schedule of pharmacist-administered vaccines is key to achieve equitable access to government-funded vaccines by all Australians, agreed Dr Sim.
‘We know that there is no one-size-fits-all approach to improving vaccine uptake, with the report rightly highlighting the need for a tailored approach to ensuring vulnerable cohorts don’t fall through the cracks,’ Dr Sim said.
‘The federal government’s move to open up NIP funding for pharmacist-administered vaccines is a welcome first step, but there is more work to be done to allow pharmacists to deliver all vaccines to patients of all ages.
‘Pharmacists can and should be utilised as trusted health care professionals, working hand in glove with the rest of the primary care team to break down the barriers to vaccination, from improving equity and access, to amplifying public health messages.’
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[post_excerpt] => With a plunge in vaccination rates following the COVID-19 pandemic peak, a new report says a focus on national consistency is required.
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[post_content] => Clozapine is indicated for the management of treatment-resistant schizophrenia. Its use is subject to strict regulatory and monitoring requirements due to potential toxicity, most notably agranulocytosis and neutropenia.
Each brand has its own protocol monitoring service1,2:
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[post_content] => Glucagon-like peptide 1 (GLP-1) agonists, traditionally used to manage type 2 diabetes, have been increasingly prescribed off-label for weight loss.
There are four GLP-1 agonist medicines approved by the Therapeutic Goods Administration (TGA) for use in Australia for the management of Type 2 Diabetes:
Anouska Feszczur MPS[/caption]
‘Patients have told me cravings and appetite return with an insatiable force they’ve never experienced before,’ she said. ‘They also experience cravings for foods they had zero interest in while taking a GLP-1 agonist.’
The hunger and cravings tend to be extreme upon cessation, evening out over the space of weeks or months, said Ms Feszczur. This cessation symptom leads to another common post-treatment effect: weight gain.
‘Evidence shows stopping semaglutide leads to weight gain,’ said Ms Feszczur. ‘In one study, all participants put on two thirds of their weight back on in a year.’
Because patients often gain back the weight they lost post-treatment, other health benefits similarly erode.
‘For example, if a patient's blood pressure or blood sugar levels improve during treatment with a GLP-1 agonist, they can go back to where they were when they stop,’ she said.
Mood can also be impacted upon GLP-1 agonist cessation. ‘Patients who felt proud of themselves for losing weight can experience guilt, shame and despair,’ said Ms Feszczur. ’They've spent all this money on treatment, and suddenly the weight has come back on.’
Lastly, some patients have mentioned an impact on impulsive behaviours when the dopamine regulation effects of GLP-1 agonists appear to wear off.
‘Almost all patients have said they drink less alcohol because they just don't get the same buzz, and one patient even stopped chewing their nails,’ she said. ‘Some people have also indicated in forums that online shopping and gambling behaviour changed while they were on Ozempic.’
Those impulsive behaviours can return upon cessation, said Ms Feszczur – rendering the holiday period, where people tend to overeat, drink and spend, a tricky time to go off these medicines.
‘It could be quite distressing for patients who feel they have no control over impulsive behaviours.’
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[post_content] => When it comes to belladonna, the eyes have it. Pity it’s highly toxic...
During the Italian Renaissance of the 14–16th centuries, belladonna was a popular cosmetic product. Well-dressed women used juice from the berries of the plant to dilate their pupils, resulting in a fashionably seductive look. Hence the name belladonna, Italian for ‘beautiful woman’.1–6
But millennia before it helped make a fashion statement, belladonna was used as an anaesthetic, pain reliever and remedy for assorted ailments, not to mention as a hallucinogenic component of rituals. It was also used as an oral poison and to tip arrows.1,5,7
Deadly nightshade, murderer’s berries, sorcerer’s berries and even devil’s berries — as belladonna’s alternative names reveal, its not so ‘bella’ side was well known. The plant was associated with broom-riding witches and poison potions.3,4,8
Shakespeare described belladonna’s impact when referring to Juliet’s attempt to feign death to avoid marriage with Paris and escape with Romeo1,4,8:
Her blood is settled, and her joints are stiff: Life and these lips have long been separated; Death lies on her like an untimely frost upon the sweetest flower of all the field.
What is belladonna?
Atropa belladonna is an ornamental plant of the Solanaceae family. It is native to Europe, North Africa and Western Asia. Growing to a height of 150 centimetres in barren stony soil, belladonna has oval leaves, green-purple flowers and sweet black berries.3-5,9,10,12
The herbaceous perennial is highly poisonous, especially the leaves and fruit. They contain atropine, scopolamine and hyoscyamine alkaloids. Consuming the alkaloids can be deadly. Just touching the leaves may cause a rash.1,6-9,10
How it works
Belladonna’s alkaloids affect the body’s nervous system. Specifically, they block the neurotransmitter acetylcholine from binding to the central nervous system and to parasympathetic postganglionic muscarinic receptors.6,7,9-11
Toxic effects can be wide-ranging, as evidenced by the case of an 11-year-old Moroccan girl treated for belladonna toxicity by the intensive care team at the Mother and Child Hospital in Fes.5,7,9
‘She was given Atropa belladonna by an herbalist in a therapeutic interest,’ they reported. Her symptoms included dry mouth, confusion, incoherent speech, and an inability to recognise family members. She also presented with uncontrollable vomiting, visual disturbances, and hearing and visual hallucinations.7
Belladonna can also cause changes to saliva, sweat, pupil size, urination and digestive functions. It can also cause seizures, headaches and increased heart rate and blood pressure.10,11
Medical uses
Today, medicines containing alkaloids found in belladonna, such as atropine, are used in areas such as emergency medicine and anaesthesia.13
Interestingly, atropine is used as an antidote of organophosphate poisoning by reversing its muscarinic effects (such as vomiting, diarrhoea, bradycardia, miosis, sweating and salivation).13
Proving the eyes still have it, atropine is also indicated for use in optometry for conditions like uveitis, myopia progression, amblyopia and sometimes for eye exams.13 Overseas, transdermal scopolamine is sometimes used to help treat nausea and vomiting-related conditions.14
References
- Fletcher J. Uses and risks of belladonna. Medical News Today. 2017. At: https://www.medicalnewstoday.com/articles/318180
- Meriney SD, Fanselow EE. Acetylcholine in Synaptic Transmission. Academic Press 2019:345–67. At: https://www.sciencedirect.com/topics/neuroscience/atropa-belladonna
- Passos ID, Mironidou-Tzouveleki M. Hallucinogenic Plants in the Mediterranean Countries in Neuropathology of Drug Addictions and Substance Misuse Vol 2. Academic Press. 2016:761–72. At: https://www.sciencedirect.com/science/article/abs/pii/B9780128002124000716
- Morris SM. Belladonna: remedy with a dark past. Healthline. 2017. At: https://www.healthline.com/health/belladonna-dark-past
- Annisadmin. Atropa belladonna: deadly nightshade. Penny Dreadful Archives. 2016. At: https://pennydreadfularchives.wordpress.com/2016/05/31/atropa-belladonna-deadly-nightshade/
- DrugBank. Belladonna. 2017. At: https://go.drugbank.com/drugs/DB13913
- Berdai MA, Labib S, Chetouani K, et al. Atropa belladonna intoxication: a case report. Pan Afr Med J 2012;11:72. Epub 2012 Apr 17. At: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361210/
- Mann J. Belladonna, broomsticks and brain chemistry. Education in Chemistry. 2008. At: https://edu.rsc.org/feature/belladonna-broomsticks-and-brain-chemistry/2020099.article
- Karagoz I, Bilgi M, Boduc E, et al. Atropa belladonna and associated anticholinergic toxic syndrome: a case report. Bali Med J 2017;3(3):S90–S92. At: https://balimedicaljournal.org/index.php/bmj/article/view/673/pdf_330
- National Library of Medicine. MedlinePlus. Belladonna. 2022. At: https://medlineplus.gov/druginfo/natural/531.html
- Banasik M, Stedeford T. Plants, Poisonous (Humans). Encyclopedia of Toxicology (Third Edition). Academic Press. 2014. p970–78. At: https://www.sciencedirect.com/science/article/abs/pii/B9780123864543000488
- Jim’s Mowing. The Essential List of Poisonous Plants in Australia. At: https://www.jimsmowing.com.au/2021/01/the-essential-list-of-poisonous-plants-in-australia/#:~:text=For%20the%20formidable%20deadly%20nightshade,has%20become%20a%20fruitful%20one
- Rossi S, ed. Australian medicines handbook. 2023. At: https://amhonline.amh.net.au
- Pruthi S, ed. Mayo clinic. 2023. Scopolamine (Transdermal Route). At: www.mayoclinic.org/drugs-supplements/scopolamine-transdermal-route/side-effects/drg-20072848?p=1#:~:text=Scopolamine%20transdermal%20patch%20is%20used,group%20of%20medicines%20called%20anticholinergics
[post_title] => Belladonna: beautiful but deadly
[post_excerpt] => Before it helped make a fashion statement, belladonna was used as an anaesthetic, pain reliever and remedy for assorted ailments.
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[post_content] => The significant rise in Australian asthma deaths is cause for immediate and widespread concern. Here’s what experts say needs to change.
Asthma deaths are again on the rise, revealed new Australian Bureau of Statistics data recently released by the National Asthma Council Australia.
There were 467 asthma-related deaths in Australia in 2022, up from 355 deaths in 2021. Most (64%) were among women – with 299 female deaths versus 168 male deaths.
Those most at risk of death are women aged 75 and older, accounting for 45% of all deaths followed by men in this age group (18%).
This is the highest number of asthma deaths recorded since 2016-2017. Deaths were down in 2021 as a result of COVID-19 restrictions and lockdowns – leading to fewer respiratory infections and asthma exacerbations. However, asthma exacerbations have now returned to pre-pandemic levels and may even be slightly higher, warned National Asthma Council Australia Director and respiratory physician, Professor Peter Wark.
[caption id="attachment_24414" align="alignright" width="225"] National Asthma Council Australia Director and respiratory physician, Professor Peter Wark[/caption]
This may be the result of the increase in virus infections we saw following the easing of COVID-19 restrictions but the main reasons are a result of the intrinsic problems underlying asthma management in Australia. ‘We're not accurately diagnosing asthma, and we are under-treating it,’ he said.
A need for better asthma diagnosis and control
There was a marked decline in lung function testing during COVID-19. Despite an increase in funding under the Medicare Benefits Schedule for spirometry, there has been a reduction of two thirds in spirometry being billed under the MBS compared to 2018–19, said Prof Wark.
‘Spirometry remains essential in the diagnosis of asthma and this will lead to under and overdiagnosis,’ said Prof Wark.
Up to 20% of people who present to a pharmacy for salbutamol haven't had their asthma confirmed by spirometry, said Advanced Practice Pharmacist and National Asthma Council Australia Clinical Executive Lead Debbie Rigby FPS.
‘Because [pharmacists] can dispense salbutamol over the counter without a prescription, we have a responsibility to ask the right questions to determine patients’ level of control,’ she said.This could include asthma control tests. The Asthma Score is an example of such a test and comprises five questions. As part of this, pharmacists ask patients to rate their symptoms on a scale of one to five to indicate their asthma control over the last 4 weeks, including:
‘This more flexible approach to treatment is ideally suited to people with mild asthma, many of whom are now at risk because they are not using an ICS preventer.’
Pharmacists should take the opportunity to provide some much-needed education to patients about the benefits of the budesonide/formoterol combination, said Ms Rigby.
‘Formoterol works just as well and quickly as salbutamol, but they're also getting some inhaled corticosteroid – which helps with the inflammatory process going on in their lungs,’ she said. ‘Whereas with salbutamol, you're just helping with the bronchoconstriction. It's doing nothing about the underlying inflammation.’
‘Up to 20% of people who present to a pharmacy for salbutamol haven't had their asthma confirmed by spirometry.' Debbie Rigby FPSOnce patients exceed a lifetime cumulative dose of 500 mg of prednisone, the health risks increase dramatically – leaving younger people who use the medicine particularly at risk. ‘Only one or two courses of prednisone in 12 months significantly increases the risk of developing osteoporosis, diabetes and infections such as pneumonia.’ Females over the age of 12 are at greater risk of poor asthma outcomes, said Prof Wark. When female patients have ongoing problems with asthma control and prednisone is needed – a biologic should be considered, he said. ‘If you're not getting good asthma control, these alternative treatments work exceptionally well for everyone, including women.’
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[post_content] => With a plunge in vaccination rates following the COVID-19 pandemic peak, a new report says a concerted push is required, with a focus on national consistency.
The Grattan Institute’s A fair shot: How to close the vaccination gap report recommends action on a National Vaccines Partnership Agreement and harmonisation of the state-based regulations that determine pharmacists’ authority to deliver certain vaccines – which currently differ in each jurisdiction.
These recommendations echo PSA’s ongoing calls for a nationally consistent approach to vaccination, and demonstrate just how far we need to go to ensure equitable access to vaccination for all Australians, said PSA National President Dr Fei Sim FPS.
Australian Pharmacist takes a look at the groups with plummeting vaccination rates, and how empowering primary care professionals such as pharmacists can help to lift them.
Older Australians and Aboriginal and Torres Strait Islander peoples are missing out
Recommended vaccine uptake rates have continued to fall over the last couple of years, particularly among vulnerable groups. At the beginning of the 2023 winter, 2.5 million Australians over 65 years of age were not up to date with their COVID-19 vaccinations – a five-fold increase from 2022.
Other findings about COVID-19 vaccination include:
The report also says that Primary Health Networks (PHNs) should be required to make ongoing progress towards reaching national targets, and must be equipped with funding to support general practice, pharmacists, and aged care providers to promote vaccination in mainstream primary care.
The recent federal government commitment of 4 years of funding to support pharmacists to deliver free NIP vaccines to eligible people will improve access, increasing vaccination locations by up to 60%.
This move will also help to ensure patients can access vaccines from a trusted provider with whom they have an existing relationship.
Crucially, the report argues that ‘the federal government should work with state governments to make pharmacy vaccination regulations consistent across Australia’.
‘State regulations determine whether pharmacists can deliver particular vaccines, who can get particular vaccines from pharmacists, and whether a pharmacist vaccination is free,’ said the report. ‘The federal government’s independent Scope of Practice Review should harmonise these regulations by removing state-specific restrictions, [and] investigate opportunities to remove restrictions on the scope of practice of Aboriginal Health Workers and Aboriginal Health Practitioners.’
A nationally consistent schedule of pharmacist-administered vaccines is key to achieve equitable access to government-funded vaccines by all Australians, agreed Dr Sim.
‘We know that there is no one-size-fits-all approach to improving vaccine uptake, with the report rightly highlighting the need for a tailored approach to ensuring vulnerable cohorts don’t fall through the cracks,’ Dr Sim said.
‘The federal government’s move to open up NIP funding for pharmacist-administered vaccines is a welcome first step, but there is more work to be done to allow pharmacists to deliver all vaccines to patients of all ages.
‘Pharmacists can and should be utilised as trusted health care professionals, working hand in glove with the rest of the primary care team to break down the barriers to vaccination, from improving equity and access, to amplifying public health messages.’
[post_title] => We need a nationally consistent vaccination approach, says think tank
[post_excerpt] => With a plunge in vaccination rates following the COVID-19 pandemic peak, a new report says a focus on national consistency is required.
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[post_content] => Clozapine is indicated for the management of treatment-resistant schizophrenia. Its use is subject to strict regulatory and monitoring requirements due to potential toxicity, most notably agranulocytosis and neutropenia.
Each brand has its own protocol monitoring service1,2:
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